Infant Mental Health

Infant Mental Health: A primary goal of attachment-based parenting

Early in my career as an occupational therapist, I had the privilege of participating in York University's inaugural Infant Mental Health certificate program.  The focus was on understanding the environmental and biological basis for infant mental health. 

Since that time I have studied the science of attachment theory and ecology, and learned the impact of our parenting approaches on infant mental health. What has struck me most across all of this learning was appreciating the impact that our environment can have on the developmental well-being of infants and young children. Our children’s environments are largely created but us in the early years, and we have a significant influence on how nurturing their environments are.

Nurturing, stable, safe, and loving environments can have a positive influence on children, including those with a history of trauma. Although we cannot change the past, what we do today to shift towards more nurturing environments can support infant mental health.


The passion I have for connected parenting in the early years and beyond is reflected heavily in my approach to supporting infant sleep.  Sleep deprivation can make even the most patient parent short-tempered and less compassionate.  Sleep-deficient infants are more easily upset, more 'wired', and often more difficult to get to sleep.  And yet, at the heart of it, infants need proximity to a loving adult who has the capacity to parent in a nurturing way. It is helpful to listen to our instincts about how to support their biological and emotional needs, and to seek support (from family, from friends, from skilled mental health care professionals) to do that.

My approach to infant sleep is to inform, to guide decisions, and to change the environment and expectations in order to progress towards sleep practices that support everyone's sleep needs.  For families who have additional challenges, including mental health issues, and trauma history, I connect families with local health care professionals who can continue to support families in ways that respect the family's needs and goals.

Understanding the huge impact that we, as parents, have on our children’s well being is not intended to add a burden. Rather, it can help make decisions easier: we can choose to meet the need. We can choose to connect. We can choose to be present with our children. And we can choose to take care of ourselves and to get support when we feel overwhelmed.

Key Messages:

  1. Attachment based parenting improves infant mental health.

  2. Our environment impacts our health.

  3. Decisions are easier when we know why attachment is important.

  4. Self-care is critical: fill your own cup so you can fill theirs too.

I am not a mental health professional. But there are talented and compassionate people in our community who are. If you are concerned about mental health and about your capacity to support a nurturing relationship with your child, reach out and seek support.

Niagara Resources:

In Niagara, local supports for infant and family mental health include:

  • Pathstone Mental Health Services, pathstonementalhealth.ca

  • Emily Pollak, Social Worker, individual and family counselling, St. Catharines, emilypollak.ca

  • Niagara Infant Mental Health website (Early Childhood Community Development Centre), http://www.eccdc.org/infant-mental-health/

Within and beyond Niagara, supports include:

  • 911 for medical emergencies

  • 411 for information about local mental health services in some jurisdictions

  • Your family physician

  • Local initiatives to support infant and child mental health

Infant Development: Play, Grow, Learn Stuff

Play, Grow, Learn Stuff

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I have been immersed in infant development my entire 18 years of practice.  Starting with my work at Peel Infant and Child Development, and continuing as coordinator of McMaster Children's Hospital's Neonatal Follow-up Clinic, my primary focus has been on assessing infant development and helping parents support infant development through play, activities, and the home environment.

Before I became a parent I figured I knew enough about infant development that my own child's milestones wouldn't be that big a deal.  I was wrong!  Watching him gain skills from day to day and week to week was incredible.  It made me realize I was in the right area of practice to fit my passion.

Since then, we've grown our family to include three young children, each of whom has developed at their own pace, and with their own strengths, interests, and motivations.  What a humbling experience it is to learn from them in a way that has deepened my understanding and appreciation of how amazing infant development is.

When it comes to supporting that development, we often cannot directly impact a child's biology.  But we surely can impact their immediate environment, adjust their activities, choose toys wisely, and support them in where they are at.

By focusing on these things, we are able to build on a child's strengths, innate curiosity, skills, and interests.  It truly is a pleasure to support families in finding ways to do this that mesh with a family's routines, priorities, and values.

To learn more about infant development, or for an assessment and recommendations to support your infant's development, reach out about my workshops or about a private consultation.

What is Normal? Six Month Sleep


 Photo credit: Studio 7042, Pexel.

Photo credit: Studio 7042, Pexel.


When it comes to understanding the normal development of independent sleep, knowing the facts can make a profound difference in our perspective on the “problem”. Understanding normal sleep patterns in childhood can be incredibly reassuring. And, frequently, this involves realizing there is no problem at all!

Knowing what is typical can help us figure out if the expectations we have (or our family has, or strangers have!) match with what is developmentally reasonable. To know that frequent night waking doesn’t indicate that we have “done something wrong” to cause our babies to have frequent night waking, but rather that it is biologically normal, can take away a lot of pressure! Putting energy into coping with the phase rather than fighting our child’s nature can be a refreshing shift from trying to fit our babies into the expectations,. This way we can model our expectations on our babies’ abilities.

In my September 12, 2018 facebook interview with Built to Birth’s Melanie Farrell, we spent an hour online chatting about what is normal, how to shift perspectives on the problem, and how to manage the challenges that come with supporting infants and young children to gradually develop the holy grail of parenting: independent sleep. One of the papers I mentioned was Sadler’s 1994 paper called (most encouragingly!) Sleep: what is normal at six months?

Here is a bit more of the detail of that paper, and why it is relevant to parents of young babies.

  • Of 640 parents who completed a survey about the sleep of their infant, only 16% reported that their 6 month old “slept through the night”.

  • 16% of the infants were reported to not have a regular sleeping pattern at 6 months of age (meaning a sleep pattern maturing from within the child, rather than a lack of ‘routine’ from the parents). This suggests that the internal regulation required for a regular sleeping pattern takes several months or more to develop. This fits with our understanding of infant development and neuro-maturation.

  • 61% were sleeping in their own room by 6 months, but many ultimately shared a bed with the parents upon waking: a whopping 43% were always, almost always, or routinely (34%) brought into mom and dad’s room upon waking.

The author suggests that knowing that these sleep patterns (frequent waking, proximity to parents during sleep) are normal can be reassuring.

What may help in re-framing the perspective of night waking in your 6 month old:

  • It is normal for babies (even at the ripe age of 6 months) to wake often and prefer proximity to mom.

  • “Sleeping through the night” is typically defined as 5 consecutive hours, not the 8-hours-a-night we come to expect as adults.

  • The pressure to have young babies “sleeping through the night” does not coincide with biologically normal sleep.

  • Trusting your instincts regarding sleep problems can be helpful, especially if baby is not sleeping as well as they ought to be because of colic, reflux, food allergies, sleep apnea, or poor air quality.

  • A return to more frequent night waking at 9 months, after a period of relatively good sleep, is normal. This tends to improve after 12 months of age.

  • The route to independent sleep is not a linear one.

  • Sometimes the best strategy is to anticipate the wave, hang on tight, recruit help, and ride it out. When mother nature is the one dictating the rules, changing course may be futile! Nature has a way, and we’d do well to consider that although our environment has changed a great deal, the nature of sleep has not.

So, what is a parent to do if they are struggling with their young child’s sleep but think it might be developmentally normal? Get support! Support can go a long way in reassuring you, in tweaking some strategies for sleep, and in emphasizing (giving you permission!) to focus on your own self-care. Parents who have sought my help and needed, primarily, reassurance, are among the most rewarding consults I’ve done because it puts the power back in parents’ hearts that what they are doing feels right, is supported by evidence, and, in the end, works to create healthy, and even joyful, bedtimes and a happy and confident independent sleeper. It may not take much to bring this power back to parent decision-making, but it can make a world of difference to how you feel about your child’s sleep.

References:

Sadler (1994). Sleep: what is normal at six months?. Prof Care Mother Child. 4 (6): 166-7.

Breath of Fresh Air -Reasons and Resources for Getting Outdoors

 Seneca, New York (image in the public domain)

Seneca, New York (image in the public domain)

 

As an OT interested in environmental health, I am excited to see how much more attention is being paid by health professionals to the importance of being outdoors in natural environments. 

Time in nature is more than just something that 'feels good'.  More time outdoors means less time indoors, where air quality is frequently much poorer.  More time outdoors also addresses many physiological needs that improve physical and mental health, energy level, hormone balance, growth, and more.  At its most basic, more time outdoors fills our evolutionary need and gives our bodies and minds the type of environment we are physiologically designed to thrive in.

I recommend more time outdoors surrounded by trees, or with sand between your toes, or soft grass to lie on for cloud gazing for families as a balm for virtually any of the challenges young families face.  And I'm not alone.  More Occupational Therapists are promoting outdoor time as an effective and evidence-based approach to a variety of challenges.  

Kathleen Lockyer, an Occupational Therapist from California, has been 'prescribing' outdoor time for over 20 years.  In April 2018, Kathleen co-led a keynote address  at Guelph Outdoor School in Ontario, Canada on the importance of accessing the outdoors.  Her website has helpful resources as does her former blog The website RxOutside.com  focuses on her Nature-Led (c) approach to supporting children.

Angela Hanscom is a paediatric Occupational Therapist whose TimberNook.com approach to taking OT outdoors for addressing such diverse issues as ADHD and autism, focuses on nature-based child-led activities.  Based in New Hampshire, Angela's approach is now modelled through mentoring, training, and certification, with programs for children running in Calgary, Alberta, and Peterborough, Ontario

OTs aren't the only ones developing unique nature-based programs for children.  Growth in interest in Forest Schools in Canada, and in child-led outdoor programs like Erin Fleming's Little Seeds playgroup and Learning in the Woods alternative education in Hamilton, Ontario are providing ample opportunity for families who want to increase their child's time in nature.  The motivation to access these programs comes in part from the aesthetics and romance of the outdoors and in part through a desire to address health and behavioural issues beyond prescriptive and medically-based approaches.  Regardless of whether the reasons are romantic or a response to specific challenges, time outdoors is time well-spent.

Just as filling our plates with nature-based foods leaves less room for processed foods, filling our days with nature-based activities results in less time indoors.  Considering the well-established evidence regarding poor air quality and its impact on child health, the more time we can spend time in healthy outdoor environments the better.  Indoor Generations' compelling video on the hazards of indoor air quality on children is rather dark in its mood but reflects the current evidence on not only the proportion of time many children are spending indoors compared to previous generations, but also the reasons why indoor air quality tends to be so poor.  

With several weeks of summer weather, and a beautiful shift to fall stretched out before us, there is ample time to rejig our days to focus more on access to the outdoors.  With some attention to our routines, a motivation to shift how our time is spent, and a desire to access an effective and free 'treatment' for many of the things that ail us, summer is a terrific time to lay the ground-work for a nature-influenced childhood for our kids.  The winter, while posing some practical and psychological hurdles, is also a wondrous time to access nature --with a bit of planning, the proper clothing, and a summer of rejigging priorities, our children can benefit from outdoor access year-round.

If you are looking for strategies to incorporate more outdoor time (including camping with kids!), and feel like making these kinds of changes is daunting, I consult to families who have questions or concerns about infant development, infant sleep, and parenting.  Nature time supports all three of these areas, and I would be more than happy to support you.  

 

Resources:  

Forest School Canada http://childnature.ca/forest-school-canada/

Indoor air and child health: https://www.velux.com/indoorgeneration

Kathleen Lockyer: https://www.kathleenlockyer.com/  https://www.rxoutside.com

Learning in the Woods learninginthewoods.ca

Little Seeds https://www.facebook.com/groups/1459957610922767/

Timbernook OT program timbernook.com and timbernook.com/canada
 

 Short Hills Provincial Park, Ontario, Canada (photo in public domain)

Short Hills Provincial Park, Ontario, Canada (photo in public domain)

Breathing in Anger: How to Cope with a Child's Rage

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Angry outbursts from our children, hurtful words from them, or a hurtfully hard megablock thrown deliberately at you...These can all trigger our own anger, hurt, and tempers.  

How do we handle such fiery hot emotions from our children while staying calm ourselves? 

How do we help our little ones regulate these intense feelings? 

What are we supposed to do to discipline them?

I will venture to say that developing our own self-regulation is the essence of helping our children do the same, and it is much more than child discipline: it is our own self-discipline!

When tempers from our children flair, we may be tempted to try to take the reigns, control the situation more tightly, force them to comply with our expectation, and threaten with punishment.  And we may soon discover that this fans the flames, leading to a child who feels unregulated, behaves in even more challenging ways (or complies out of fear, rather than connection) and may lead to us reaching a boiling point too.

Here are some ideas for managing ourselves in the heat of the moment.  Start here.  Start with you.  When you feel calm, and open, and able to cope, then you can more effectively help your child to feel calm, and open, and able to cope too.

 

  • Breath in, breath out.  Whether it is to slow down your heart rate, buy time to think of an action plan, or to model calmness that you hope will rub off, taking a deep breath in, and out can be a first step.  You do not need to know what to do next.  You simply breath.  And breath again.

 

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  • Make your breath count.  Pema Chodron, an American Buddhist monk, teaches the meditation of Tonglen: to send and receive; to breath in the anger and the hurt of another, and to breath out calmness, love, and joy.  Regardless of your religious beliefs, you may find this resonates with you as a way of making your breath meaningful not just in practical ways but in ways of the heart too.  If approaching your breath this way helps  you feel more open to accepting your child's anger, lovely!  If not, the simple act of a deep breath in and out still works to calm an excited nervous system.

 

  •  Know there is a reason behind it.  Challenging behaviour is a sign of a need.  We may not always understand our children's anger, but if we know that a need is at the base of it, then we can respond in a way that looks to meet that need.  Often, with negative behaviour, we look to an emotional need: fear, embarrassment, hurt, shame, insecurity.  And often this is the key.  At other times anger and challenging behaviour may reflect physical pain, illness, or physical discomfort.

 

  • Provide your presence, not your advice. Gordon Neufeld, developmental psychologist in British Columbia, discusses ways of being present for a young child (or adult too!) who is challenged with big emotions.  When your child is lashing out in anger, stay close but not too close, talk quietly and calmly but not too much. Do not correct, until you connect.  Dr. Bruce Perry, an American psychiatrist specializing in childhood trauma, describes this as three steps: regulate, relate, then reason.  Understanding that none of us can process information very well when we are angry is helpful to remember when being present for our angry child.
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  • Give another outlet -a physical one- for your child to release this anger.  Ripping paper, kicking a garbage can. And yes, even emptying the garbage can onto the floor.  If you can find a way to stay calm with it, then let it happen (though I've certainly swooped in to rescue a cherished bowl or other breakable object!).  I know it seems counter-intuitive perhaps to let children destroy things, but I have found that the wider the girth I give my kids to release their anger, and the less upset I am with it, the more I see the limit of what they will do --at one point I told my angry preschooler, who was holding a book in a way that suggested he was about to rip it, that it was ok; that if he felt that angry he could rip the book. And he didn't. He almost melted into the permission as if he wanted to know just how far it would be before my unconditional love stopped. And he realized it doesn't.  It is not always easy to stay that calm --but when it happens it feels like reaching the sweet spot of parenting: remaining calm in the tempest.

 

  • Use simple language to calm the situation.   We cannot process language very well when we are angry.  And yet, calm, rhythmic, repetitive, and simple language can help us calm down, and can help give us tools for coping.  I think this is why 'mantras' are so helpful for those who meditate.  At young ages especially, talk in simple sentences (e.g. it is ok to be mad, it is not ok to hurt me, repeated).

 

  • Use simple language to "correct" the behaviour or to reason with your child.  When both you and your child are calm, then address the behaviour.  For young children this will be more direct and simple, and can include words that acknowledge their anger, their behaviour, and gives an alternative.  For older children, reasoning around why some things are not ok to do, and looking at ways they can cope with angry feelings next time can be helpful.  Physical closeness can be an important part of this.  By continuing to use simple language, we can avoid 'giving a lecture' or bringing up past behaviours.  We can focus on empathy, reflection, and problem solving instead.

 

  • Go for the long haul.    Sometimes the hard work we do parenting through challenging situations doesn't bear fruit for a long time.  Our children may make the same mistakes over and over, or take a very long time to develop enough self-regulation to stop pushing their sibling, throwing things, or biting when angry.  Think of this in the long term.  However, you may also find that the work you do in regulating your emotions gives you wonderful payoffs right away:  when I stay calm through the tempests of my middle child (which is not always!), I am often met with a spontaneous "I love you" when things are calmer.  I take this "I love you" to also mean "thanks for staying with me through that.  Thank you for not getting mad".  

 

It is a very challenging thing to regulate our own emotions when trying to help our children develop self-regulation skills.  It can trigger a lot of hurt and anger in us that makes it difficult to meet the needs of our children.  Hugs to anyone who has had to dig deep to stay calm with their angry child.  It is no easy thing.  As Laura Markham, Clinical Psychologist, has said, our own self-regulation is the foundation of effective parenting.